Harvard T.H. Chan School of Public Health, 677 Longwood Avenue, Kresge 7th floor, Boston, MA, 02115, USA.
Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
BMC Public Health. 2020 Oct 9;20(1):1531. doi: 10.1186/s12889-020-09632-2.
Human Papillomavirus (HPV) vaccination among adolescents is an important strategy to prevent cervical and other cancers in adulthood. However, uptake remains far below the Healthy People 2020 targets for the US. Given the barriers to population-level vaccination policies and challenges to incorporating additional action items during clinical visits, we sought to explore alternative delivery mechanisms, specifically delivery of the vaccine in community settings.
We conducted six focus groups (three with adolescents aged 11-14 who had not received the HPV vaccine and three with caregivers of adolescents meeting those criteria) from Black, Latino, and Brazilian communities in Massachusetts. We utilized a framework analysis approach that involved a multi-stage coding process employing both prefigured and emergent codes. Initial interpretations were refined through consultation with an advisory board.
Adolescents and caregivers expressed a range of concerns about the HPV vaccine and also described interest in learning more about the vaccine, emphasizing the importance of a relationship with a trusted provider as a facilitator of vaccine acceptance. Regarding community-based delivery of the vaccine, reactions were mainly negative. However, adolescents and caregivers noted that receiving information in community settings that could seed a conversation with a trusted provider would be welcome. Interestingly, the notion of a trusted provider seemed to extend broadly to practitioners linked to the trusted main provider.
The study highlights an opportunity for increasing HPV vaccination among some racial and ethnic minority populations by leveraging trusted community organizations to provide information and seed conversations with a potentially broad group of trusted providers. A task-shifting approach, or reliance on staff with fewer formal credentials, may offer opportunities to support vaccination in resource-constrained settings.
在青少年中接种人乳头瘤病毒（HPV）疫苗是预防成年后宫颈癌和其他癌症的重要策略。然而，这一接种率远远低于美国“健康人 2020”目标。鉴于人群级疫苗接种政策的障碍，以及在临床访视中纳入更多行动项目的挑战，我们试图探索替代的疫苗接种途径，特别是在社区环境中接种疫苗。
我们在马萨诸塞州的黑人、拉丁裔和巴西社区进行了六项焦点小组（三组是未接种 HPV 疫苗的 11-14 岁青少年，三组是符合这些条件的青少年的照顾者）。我们采用了一种框架分析方法，该方法涉及一个多阶段的编码过程，既使用预先设定的代码，也使用新出现的代码。初步解释通过与顾问委员会协商进行了完善。
青少年和照顾者对 HPV 疫苗表达了一系列担忧，同时也表示有兴趣更多地了解疫苗，强调与可信赖的提供者建立关系是接受疫苗的一个促进因素。对于在社区环境中接种疫苗，反应主要是负面的。然而，青少年和照顾者指出，在社区环境中获得信息，可能会与可信赖的提供者进行对话，这是受欢迎的。有趣的是，可信赖的提供者的概念似乎广泛地扩展到与可信赖的主要提供者有联系的从业者。
这项研究强调了通过利用可信赖的社区组织提供信息并与潜在广泛的可信赖提供者进行对话，为一些少数族裔群体增加 HPV 疫苗接种的机会。任务转移方法或依赖于具有较少正式资格的工作人员，可能为资源有限的环境提供支持接种的机会。
